Project Summary/Abstract Over four million older adults undergo high-risk surgery every year; yet geriatric-specific risk factors and long- term outcomes after high-risk surgery are not well studied. Improving our understanding of functional, mental, and social factors beyond medical factors and their associations with outcomes is essential to providing patient-centered geriatric surgical care. The long-term goal is to broaden our understanding of the quality of life in this population and to direct surgical care towards this aim. The objective of this application is to gain an understanding of the long-term mortality and functional recovery outcomes in older adults after their high-risk elective surgery. The central hypothesis is that there are geriatric specific risk factors that affect long term mortality and functional outcomes in older adults after high-risk surgery. This hypothesis will be tested by leveraging the Health and Retirement Study (HRS) for longitudinal data on a nationally representative cohort of older community-dwelling adults and Medicare data to pursue two specific aims: 1) Describe the long-term (up to 2-year) survival rate following major surgery, and to identify individual patient characteristics (i.e. functional, medical, and psychosocial factors) associated with mortality.; and 2) Determine long-term functional recovery outcomes following major surgery and determine factors associated with functional decline. We will assess long-term (on average, 12 months) functional recovery outcomes (i.e., change in activities of daily living (ADL) and instrumental activities of daily living (IADL)) and factors associated with these outcomes following high-risk elective surgery. This project is innovative because it is the first to use a nationally representative dataset focused on community dwelling older adults to look at long-term outcomes and geriatric specific risk factors in older adults who underwent an elective high-risk surgery. The proposed research is significant because it will greatly enhance our understanding of important geriatric-specific risk factors that are associated with long-term outcomes.